Which of the following statements about chronic mesenteric ischemia due to atherosclerosis is/are correct?
- Postprandial pain in these patients is due to gastric hyperacidity and in most cases is relieved with H 2 blockers.
- Men are more often affected than women
- Mesenteric endarterectomy is the surgical treatment of choice, since long-term patency rates are superior to mesenteric bypass.
- Arteriography is no longer necessary in these cases since noninvasive diagnosis can be established using duplex ultrasound scanning.
- Surgical treatment is indicated to prevent intestinal infarction in symptomatic patients.
Medicine
E. Surgical treatment is indicated to prevent intestinal infarction in symptomatic patients.
DISCUSSION: The precise cause of postprandial pain in patients with chronic mesenteric ischemia is unknown. Hyperacidity has been observed in some patients with this disease, and gastric pH may be reduced after successful revascularization. No medical therapy, including H 2 blockers, has provided symptomatic relief. Unlike most syndromes of ischemia due to atherosclerosis (coronary, cerebrovascular, peripheral vascular), chronic mesenteric ischemia occurs more frequently in women. The long-term success rates for mesenteric bypass and mesenteric endarterectomy are equivalent; either technique is acceptable. While duplex scanning is a useful noninvasive screening technique in these cases, arteriography is required for definitive diagnosis and to plan revascularization. While prospective, natural history studies have not been done, an increased risk of intestinal infarction is undeniable in these patients. When this occurs, patients rarely survive. Elective surgical revascularization is indicated in symptomatic patients with severe mesenteric arterial occlusive disease.
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